For most, October means witches and bats, trick-or-treating and scary movies. For some, it’s tied to pink ribbons and breast cancer awareness, but for others, it’s a time to remember the loss of what was, or what could have been.

October is Pregnancy and Infant Loss Remembrance Month. It was first marked a national day of observance by former President Reagan back in 1988 – who the Wall Street Journal named “the father of the pro-life movement.” His “Abortion and the Conscience of the Nation” played on the idea of defending the life of unborn babies, and expressed the need for Roe v. Wade to be overturned.

From rhetoric to policy, the Reagan administration has a major impact on the U.S. reproductive rights movement. In his 1983 essay, Regan likened Roe v. Wade to the Dred Scott decision of 1857, which upheld slavery and denied Black citizenship. This comparison between slavery and abortion continues to be used by conservative politicians like Mike Huckabee, with some pro-lifers referring to themselves as abortion abolitionists.

His choices for the Supreme Court greatly affected the discussion on reproductive rights, with Antonin Scalia opposing Roe v. Wade and Sandra Day O’Connor supporting it in crucial cases.

“I’m wondering if this was a subtle way to put a perception on the American people that again, all babies that are lost are mourned and that it [abortion] is not a relief,” said Dr. Julie Bindeman, reproductive psychologist, founder and co-director of Integrative Therapy of Greater Washington.

In Post-Roe America, pregnancy loss has been criminalized through some state policies that implement “fetal personhood.” This can include cases in which a pregnant person experiences misscarriage or stillbirth, and had drugs in their system, or refused medical treatment, for example.

The American College of Obstetrics and Gynecologists estimates that 26% of pregnancies end in miscarriage, making it the most common form of pregnancy loss. Miscarriage, early pregnancy loss, occurs before 20 weeks of gestation, and according to the March of Dimes, a pregnancy loss that occurs after that point is considered stillbirth.

Despite its anti-abortion origins, this month is still an important time used to bring awareness to pregnancy and infant loss. Losing a wanted pregnancy can be devastating to expectant parents. Though it is quite common, many parents who’ve experienced loss refrain from talking about it due to stigma and shame. Bindeman says there are many nuances behind grieving this type of loss.

Types of grief

Bindeman points out that grief, in the traditional sense of how we understand it, is retrospective. Usually, people are able to look back at memories, and because the loss is often visible, mourners usually have friends or family to share the loss with.

“So you’re not grieving alone, and there’s something that is really important to people about having community when they grieve,” said Bindeman.

Loss of a pregnancy, and sometimes infant loss, is more of a prospective loss. Rather than mourning the life of a child, it’s the mourning of what the child’s life could have been.

“You’re also losing a perception of what your future was going to look like,” Bindeman said. You lose that script that you’ve created in your head about what it was going to be like to have a kid, and things you’re going to teach that child, and do with that child, and how you’re going to express your love for that child. It means that all of this gets interrupted.”

Parents in this situation have few or no direct life experiences with the unborn child, which can make mourning more complicated.

“It’s really hard for our culture to conceptualize someone as a parent, unless they are actively raising a child,” Bindeman said. “If you don’t have a child in-arm, you’re not going to be identified as a parent. So that’s part of the prospective loss, is in that role, in that identity that you are assuming of a parent.”

Anticipatory grief refers to the distress one feels in the days, months, or years leading up to the loss or death of a loved one.

“It’s the experience of knowing that a change is coming, and starting to experience bereavement in the face of that,” Dr. Allison Werner-Lin, licensed clinical social worker and associate professor at the University of Pennsylvania’s School of Social Policy and Practice told Forbes Health in September.

It’s something that may set in for parents in premature birth cases, or for those who experience in-utero complications and are told their baby might not survive.

The mental effects

“Because it is medically common, the impact of miscarriage is often underestimated,” said Dr. Janet Jaffe, clinical psychologist at the Center for Reproductive Psychology. “But miscarriage is a traumatic loss, not only of the pregnancy, but of a woman’s sense of self and her hopes and dreams of the future. She has lost her ‘reproductive story,’ and it needs to be grieved.”

The mental and physical tolls of pregnancy loss often lead the birthing parent to blame themselves or feel betrayed by their body.

“Oftentimes, people start to doubt their parenting skills or their fitness to be parents because inevitably, no matter what kind of loss it is, most parents I work with will trace it back to ‘I should have,’ ‘I didn’t,” Bindeman said. “And most of the time, even if they had done those things that they feel like they should have done, it would not have changed the outcome.”

Research shows that pregnancy loss is associated with anxiety and depression, with 55% of women experiencing symptoms of depression, 27% perinatal grief and 18% anxiety.

Bindeman says that bereavement for a child tends to be the most intense during the first six months, and within the first year of the loss with trigger points like due dates, what would be baby’s first birthday, and other milestones spiking emotions.